A nurse is caring for a patient who has a blood glucose of 52 mg/dL and is lethargic but can follow simple instructions.
Which action should the nurse perform first?

Choice A rationale

Chronically low blood pressure and dehydration are not characteristic of Cushing syndrome. Cushing syndrome is caused by prolonged exposure to high levels of cortisol. Cortisol, a glucocorticoid, increases sodium and water retention and potassium excretion. This fluid retention leads to increased blood volume and hypertension, not low blood pressure. The patient would typically have fluid overload, not dehydration.

Choice B rationale

Decreased axillary and pubic hair, known as sexual hair, is not a typical finding in Cushing syndrome. High cortisol levels can lead to excess androgen production, which in females may result in hirsutism, or excessive growth of male-pattern hair, including on the face, chest, and back. Decreased sexual hair is more commonly associated with conditions like Addison's disease or hypopituitarism, where there is a deficiency of adrenal hormones.

Choice C rationale

Purplish-red abdominal striae and a "moon face" are classic signs of Cushing syndrome. The high cortisol levels cause collagen breakdown, leading to thin, fragile skin that easily tears, forming these striae. The fat redistribution caused by cortisol excess leads to central obesity, a rounded or "moon" face, and a buffalo hump on the upper back. This combination of physical changes is pathognomonic for the condition.

Choice D rationale

Bulging of the eyes, or exophthalmos, and intolerance to heat are classic signs of hyperthyroidism, specifically Graves' disease. These symptoms are caused by an autoimmune process where antibodies stimulate the thyroid gland to produce excess thyroid hormones. They are not associated with Cushing syndrome, which is a disorder of the adrenal cortex and its regulation.

Choice A rationale

Assessing the patient's voice is important for detecting potential laryngeal nerve damage during the surgery, which is a risk of total thyroidectomy. However, this is a monitoring action. The most critical, immediate concern post-operatively is related to preventing injury and managing potential airway compromise, which is more directly addressed by other interventions.

Choice B rationale

Encouraging the patient to ambulate postoperatively is important for preventing complications such as deep vein thrombosis and pneumonia. However, it is not the highest priority intervention immediately following a thyroidectomy, which is focused on preserving the integrity of the surgical site and preventing neck strain.

Choice C rationale

After a total thyroidectomy, the most critical intervention is to avoid extending the patient's neck. This is to prevent tension and stress on the surgical incision and sutures, which could lead to wound dehiscence or bleeding. This also protects the airway and prevents pressure on the trachea or recurrent laryngeal nerves.

Choice D rationale

Administering oxygen as needed is a valid intervention, particularly if the patient has signs of respiratory distress, which is a potential complication of neck surgery. However, maintaining the neck in a neutral, non-extended position is a foundational and continuous priority to prevent direct trauma to the surgical site and the structures within.